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14th February 1999

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Do you know that in Sri Lanka 500 abortions are done each day?

Death before birth

By Kumudini Hettiarachchi

Death before birthIt is a dirty word in traditional Sri Lankan society. It is hardly discussed, and if it has to be talked about it is done in a hush-hush manner, behind closed doors. If it has to be resorted to, for whatever reason, it is done surreptitiously and stealthily.

Yes, we are talking of abortion, the taboo subject in our dharmishta homeland. But what is the reality? The reality is shocking. We don't talk about it, we deny its existence, but the statistics cry out a different and terrifying story. Just to think about it is shocking - 500 to 750 illegal abortions take place each day.

That's not all. According to random statistics disclosed by health experts at a meeting with the media organised by the Health Education Bureau, the Ministry of Health and Indigenous Medicine and the United Nations Population Fund at least 5% of those who undergo abortions die as a result, while another 60 to 70% suffer serious complications.

On a conservative estimate, let's take the lower figure of 500 abortions a day. Let's leave out Sundays and other holidays and take the year as having about 300 working days; then about 150,000 abortions take place each year.

Remember abortions are illegal in Sri Lanka, unless the termination of the pregnancy is deemed essential to save the life of the mother. However, what about certain other situations, which the mother herself may think warrant an abortion. The three most important issues which come to mind are:

    * If during the early stages of pregnancy, the foetus is detected as having serious congenital problems
    * If the mother-to-be is a victim of incest
    * If the mother-to-be is a victim of rape

How do we, as a moralistic society, which for all purposes abhors abortion (though in reality 500 women seek abortions daily) help the women mentioned above? Do we give the women who have babies with congenital defects life-long support to look after their children?

Do we have adequate institutional support for such mothers?

Do we accept the illegitimate children of incest and rape victims, without discrimination or do we dub them "bastards" forever, with even the mother having to face the stigma through no fault of her own?

These are, of course, the extreme cases. What about that "unplanned" baby that most couples cannot afford to bring up?

According to the Medical Director of the Family Planning Association (FPA), Dr. Sriani Basnayake about 66% of married couples who fall within the reproductive age category practise contraception, but one-third (about 22%) of this number still use the traditional or natural (rhythm or withdrawal) methods which have a high failure rate, as against modern scientific methods such as condoms, pills, injections and loops.

Even the modern scientific methods are not 100% effective. If a couple who has two children and are strictly adhering to contraception, finds that the woman is pregnant, shouldn't they be given an option? she asked.

Dr. Basnayake explained that in1998, 353 women came to the FPA's clinic in Colombo requesting a termination of their pregnancy, under the mistaken belief that the FPA performs abortions. There were at least 50 others who did not specify that they wanted an abortion, but got their urine checked for pregnancy because of delayed menses and went off when they heard that abortion services were not available. Of those who attempted to seek abortions at the FPA there was a 50-50 ratio of married to unmarried.

Attempting to explain the very high rate of abortions in Sri Lanka, she said, "We have to accept the fact that the age of marriage among women is high (average age for women is about 26 and for men about 29), but that does not mean that they are sexually inactive. Sexual feelings occur from the mid-teens and with the exposure to the mass media where love is talked about freely, and other pressures of day to day living, it is natural for them to experiment and indulge in pre-marital sex."

Cultural values are changing and there is much freedom between the sexes. They work together. Data is scarce. However in a Sri Lankan study on unmarried youth between 16 to 29, when asked whether they have had sexual intercourse, 42.6% of urban and 28.5% of rural males had said yes, as against 6.3% of urban and 3.9% of rural females, she said.

There isn't a simple yes or no answer to the question whether abortion should be legalised or not. There are many ethical, religious and social issues which come into play when considering this issue.

But isn't it time we brought it out into the open and had debates and discussions on a matter which seems to affect about 150,000 women directly and their families indirectly? Don't these women have a right to come out with their views which the authorities should give ear to?

On the other hand the arguments against abortion would be equally strong. What about the life of the child? Doesn't he/she have a right to life? What have they done to deserve death, even before being born? Who has the right to take another's life? In the extreme, if abortion is legalised would it not be misused like in India, to get rid of a daughter if the parents wish for a son and vice versa, after using the latest technology such as ultra sound scanning to determine the sex of the foetus?

Stressing that it was her personal view, Dr. Basnayake said everyone talks of the sanctity of life and the rights of the unborn child. But what about the mother? Doesn't she have any rights? The mother is just considered a vessel to carry the unborn baby. Isn't she a human being? When abortion is illegal, the government cannot supervise. Most of the non-affluent women are at the mercy of quacks.

"Everybody knows unsafe abortions are taking place under septic conditions, using crude methods and with untrained staff. But like the ostrich, we hide our heads in the sand and pretend everything is okay. But it is not okay.

"Who suffers? The poor woman who undergoes an unsafe abortion - sometimes she dies, sometimes there is permanent damage to her reproductive system, leaving her infertile or semi-fertile," she said.

Former Secretary-General of the International Planned Parenthood Federation, Bradman Weerakoon, who is a consultant to UNFPA's Colombo office, says, on a rough estimate, there are about eight million Sri Lankans (around four million couples) in the reproductive age and some of them are having unprotected sex, leading to unwanted pregnancies.

How does a lower income person cope with an unplanned pregnancy? They go in for an illegal abortion or have the unwanted child and put the child on the street. Then delinquency increases, he said.

Mr. Weerakoon said, "That's why women's movements are keen to give the choice, of carrying the pregnancy to full term or terminating it, to the mother or father to determine."

On the archaic law relating to abortion, he said, "It comes from the Penal Code and is over 120 years old. Under this law the termination of pregnancy is illegal unless it is done to save the life of the mother. The mother must be in a life-threatening condition."

Three years ago, Justice and Constitutional Affairs Minister G.L. Pieris, during amendments to the Penal Code, introduced a small amendment to the abortion law, to make medical termination permissible in the case where the foetus might have congenital deformities or in cases of rape and incest. But this was withdrawn following pressure from different groups.

Though he assured that he would bring forward some amendments in due course in a more comprehensive law, three years have passed and nothing has happened.

Dr. Basnayake says that if the law is to be changed there must be an adequate number of centres with trained staff and facilities all over the country. It should also be tied up with pre and post-abortion counselling for the mother.

According to Mr. Weerakoon, there is also a need to increase contraception, to bring down the abortion rate.

Then the question arises, though Sri Lanka has been lauded for its successful family planning programmes, in reality has it failed considering the fact that so many women seek abortions each day?

No, says Dr Basnayake. Perhaps the target group may be inadequate. The family planning programme of the government, unlike the FPA, caters only to married people. The government clinics all over the country issue a form which requires details such as "husband's name, age and level of education" to any potential contraceptive user. For unmarried couples who are sexually active this becomes a hindrance in seeking contraception, she explains.

What can be done to reduce the large number of abortions? Dr. Basnayake puts forward three recommendations:

    * Introduce sex education for adolescents. Let them know about their bodies and how things such as pregnancies occur.
    * Promote modern scientific methods of family planning - even though people know of such methods, there is a big gap between knowledge and practice. The fear of old wives' tales needs to be overcome.
    * Accept the fact that as the age of marriage among women is high there is a group who are unmarried, but sexually active and make contraception available and easily accessible to them.

Mr Weerakoon adds that the consequences of illegal abortions are:

    * the act is illegal, but no action is taken by the police against it, spreading the feeling that the law can be broken. By non-implementation of the law, it is brought into disrespect.
    * the trauma for the woman becomes greater, because abortions have to be done stealthily. There is also a stigma attached to it.
    * the rich have a benefit over the poor, as they can pay and get it done by a medical practitioner in better hygienic conditions.

As both Dr. Basnayake and Mr. Weerakoon emphasised, abortion is a very problematic area in which society does nothing. But the time has come, with 500 abortions a day, for Sri Lanka to open its eyes to this serious issue, without pretending that if we ignore it, it will go away.

Decisive action, after debate and open discussion, is the need of the hour. High priests from all religions in the country publicly oppose abortion on religious grounds and the fact that it takes a life away. But religious dignitaries, I believe would express different thoughts in private given the fact that this is a human and practical problem, and is in desperate need of a practical solution.

What is required is a brainstorming of ideas and thoughts on these issues at a closed-door seminar by all parties concerned - medical practitioners, abortion clinics, police, government officials, the ministers of health and cultural affairs, religious dignitaries, women's activists, family planning experts and a group of women who have undergone abortions.

Given the sensitivities of the issue, maybe the print and electronic media should, together decide not to report the proceedings of the meeting, in the interests of the larger issue of finding a solution to a problem that mankind has grappled with for centuries. Religious groups, who are the main opposers to abortion, are unlikely to freely express their views, if they are worried about media publicity.

The abortion debate is an old topic that is occasionally raised in the media. But little has been done about the problem and the solution.

Entered, withdrawn

Last Wednesday, a young colleague and I visited a "family planning clinic" in the heart of bustling Kollupitiya. Everyone knows it happens there. You go in, pay a fee of Rs. 900, get it done by a doctor under reasonably hygienic conditions and walk out as if nothing has happened.

So we walked in at about 2.30 p.m. that day and found about 30 to 40 people seated in the garage which had been turned into a "waiting room". Many were youngish women, some with their husbands and others with an elderly relative.

The reception counter and cashier desk were unmanned in the brightly-lit hall. Not finding anyone, we walked into a room and saw two men and two women in nurses' uniforms playing cards. We were told curtly that it was lunch-time. The doctor would be in at 3 p.m.

Seated outside, we got into conversation with a woman who seemed to be in her early-30s. She was from Gampaha. She was a veteran, this was her third trip here. She had three daughters aged 15, 10 and eight. She came here first soon after her second child was born and she realised she was pregnant again. This time, her husband had returned from abroad. She was on the pill, but she had conceived. She suspected it was about three months.

Recently, she saw a programme on TV where religious leaders had spoken against abortion. She just could not bear to think of going through the hassle of nappy-changing and midnight cries.

She could have got it done in Gampaha but it was more expensive there. They had asked for Rs. 1,500. So here she was with her husband. There was nothing to be scared. It took just 10 minutes.

"Sihiyanethi karanawada?" (Do they anaesthetise ?) I ask and she laughs. "Ne, ne womb ekata injection ekek gahanava. Denennewath ne." (No, only an injection to the womb).

Suddenly the nurses are active, commanding the people to form a queue. We too join the line to see the receptionist. While everyone else peers into the cubicle, you walk in, tell the receptionist something and get a chit written. Then you stand in line at the cashier and pay Rs. 900 for "any investigation and treatment" as proclaimed by a board near the counter. After that you head upstairs.

The receptionist, obviously didn't like my looks and the fact that I had not come with my husband or an elderly relative. "Wait for the doctor," was her instruction. We join the OPD queue, where other ailments are treated, and see the smartly-clad doctor in tie, who walks in. A sympathetic woman who has accompanied her "sister" tells us, "Kiyanna thibbe Maharagama Dr. ... evve kiyala."

Then a nurse barks at us. Where are you from? Where is your husband? Why haven't you come with your mother? Did a doctor give you a letter? When we say we are in a hurry, she shouts, "Meva ikmanata karanna be," but allows me to jump the queue and see the doctor. My colleague is asked to wait outside.

Just as I begin to explain… the doctor gives a knowing nod and proceeds to ask me where my husband is, what he's doing and whether I'm sure that I have my husband's consent to do it.

I stammer a little, but get through the questioning without a major problem. He writes a chit and I come out. The nurse says we have to pay the money and go upstairs and await the doctor.

We say we are in a hurry and ask whether we can come another day.

The nurse gets angry and says we would have to explain to the doctor, return the chit and come again. As she walks into the doctor's shaded room, we hurry out, not looking back.

The trishaw drivers outside the innocuous "clinic" give us knowing glances and I notice that my colleague is perspiring. We've just been to a "clinic" which kills babies even before they are born, nay even before they are properly formed. We leave with the thought, "If abortion is illegal, what are the police doing?"

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